Endotracheal intubation and mechanical ventilation in critically ill are life saving interventions. The process of discontinuing ventilatory support begins with the recognition of adequate recovery from acute respiratory failure. However, extubation is more than just removal of the endotracheal tube. Extubation in ICU should be carefully planned and every effort should be made to minimize the chances of failed extubation. In this article, we look at some of the aspects of extubation and interventions that may improve the chances of extubation success, particularly in patient subgroups at high risk. The pathophysiological causes of extubation failure include an imbalance between respiratory muscle capacity and work of breathing, upper airway obstruction, excess respiratory secretions, inadequate cough, encephalopathy or cardiac dysfunction. Thus, the peri-extubation period involves an assessment of whether a patient can be weaned off ventilatory support but also, whether the artificial airway can be removed safely. Failed extubation increases morbidity and mortality. With so many variables involved that affect outcome extubation requires meticulous planning. Careful and step-wise consideration of factors in individual patients is the key to success.